Provider Demographics
NPI:1033470406
Name:CHAYREZ, ANGEL (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:CHAYREZ
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1953
Mailing Address - Country:US
Mailing Address - Phone:602-486-7391
Mailing Address - Fax:
Practice Address - Street 1:418 N 4TH ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1953
Practice Address - Country:US
Practice Address - Phone:602-486-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4974224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant